THE PLANTAR REFLEX - RePub

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with ancillary investigations. In other patients, with established supranuclear weakness, the matter is more theoretical. Thus, the 30 patients were subdivided according to the problem that arose as a result of the uncertain plantar responses. 1. An unexpected Babinski response? In eight patients there were possible Babinski signs, which did not fit in with the history and the rest of the neurological examination. The EMG was normal in all of them. In table XII, the EMG outcome is shown for each of the two investigations, together with the neurologist's opinion about the plantar reflex at the time of the study, with the final clinical diagnosis, and with special features which were noticed during the author's examination. In this and the next group of patients, a dubious upward response was the clinician's most common choice; those who rated possibly downward or absent plantar responses apparently retained some doubt, since the patient was referred for this study. It can be seen from the table that the eventual neurological diagnosis was still incompatible with a Babinski sign in all eight cases. 2. An additional Babinski response? In 10 patients (table XIII) some clues already implied disease of the central nervous system, but not necessarily involving descending pathways to the side in question, and the neurologist wondered if the equivocal plantar reflex indicated an unexpected localization. The EMG showed EHL reflexes in two patients, was normal in five, and contradictory in three. 3. The missing flexor response. Two patients showed unilateral absence of the plantar reflex, perhaps pathological, because for other reasons an intracranial lesion was suspected. EMG recording gave evidence of FHB activity on both occasions in these two patients, and subsequently no cerebral lesion could be substantiated in either of them. 4. An expected Babinski response is equivocal. Ten patients showed dubious plantar reflexes in the presence of other pyramtdal stgns on the affected side. In four an EHL reflex was shown by electromyography on both occasions (two probable, two definite), in one only the first time; the clinicians had not rated a downward response in these cases. Of the remaining five patients, an FHB reflex was found in four, and no reflex activity in one. We can summarize the comparison of EMG results with the eventual clinical diagnosis as follows: the EMG never indicated a pathological plantar reflex when the central nervous system was after all supposed to be normal, whereas the criteria were wide enough to identify expected, but clinically unconvincing, Babinski signs. 96
patient 2 3 4 5 6 7 8 sex F M M F F M M F TABLE XII PATIENTS SHOWING EQUIVOCAL <strong>PLANTAR</strong> RESPONSE AS AN ISOLATED FINDING age .ride clinicit~n's EMC; fintd clinical commenls (J'r) opinion reflex diap,noJiJ 71 R absent? l.l'HB none (complaint: voluntary contraction of T A 2.PHB 'heavy legs') 51 L upward? 1. FHB? sciatica l jerky voluntary toe movements 2. FHB' 22 R upward? I. FHB neuritis of brachial flexion reflex +++ bilaterally, and brisk 2. PHil? plexus downward response of toes; once all movements have ceased, hallux goes up' again 21 L upward? 1. none lumbago hallux immobile, little toes down 2.none 43 R absent? I. FHB' hysteria 2. FH!l? 46 L upward? 1. none polyneuropathy of toe movements just possible 2. none unknown cause 28 L upward? I. none polyneuropathy flexion reflex ++ bilaterally; abundant 2.none (post-infectious) voluntary activily 55 R upward? I. FH!l non-specific oro- second roes amputated - shift of first 2.PHB facial pain R metatarsal bone? "' '-'
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THE PLANTAR REFLEX a historical, cl
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THE PLANTAR REFLEX A HISTORICAL, CL
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Aan mijn ouders Aan Carien, Maarten
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TELEOLOGICAL SPECULATIONS - science
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- EMG result and 'final' neurologic
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LIST OF ILLUSTRATIONS figure page 1
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Electromyographic recording from mu
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The plantar reflex before Babinski
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viz. those of Striimpell (1899), Op
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These early reports did not reach m
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Charcot's concepts about hysteria w
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TABLE I STUDIES CONFIRMING BABINSKI
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False positive findings? Babinski's
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FLEXION AND EXTENSION SYNERGIES The
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confirmed by Walshe (1914). His is
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esult in disappearance of the Babin
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without an ipsilateral upgoing toe
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RIVAL SIGNS Confusion When Babinski
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8. Stroking the anterior surface of
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Contradictory findings THE PLANTAR
Page 45 and 46: Bersot 1920,'2! ? X ]l 2 Burr 1921
Page 47: curious case of one healthy infant
Page 50 and 51: 9. Infants under one year of age ge
Page 53 and 54: INTRODUCTION Observer error: examin
Page 55 and 56: following a suggestion that most re
Page 57 and 58: TABLE IV INFORMATION PRECEDING THE
Page 59 and 60: TABLE VI RATINGS OF 'INFORMATION' G
Page 61 and 62: unm i stakab I y upward possibly up
Page 63 and 64: Clinical experience appeared to be
Page 65: CHAPTER III BABINSKI SIGN: STIMULUS
Page 68 and 69: TABLE VII CLINICAL COMMENTS ON THE
Page 70 and 71: Normal plantar response: flexor hal
Page 72 and 73: I. rn. extensor hallucis longus 2.
Page 74 and 75: TABLE VIII OCCURRENCE OF REFLEX ACT
Page 76 and 77: ecruited and even interrupted by EH
Page 78 and 79: value (the minimal stimulus intensi
Page 80 and 81: FIGURE 8 Relative dimen.riom and we
Page 82 and 83: the two separate bursts of electrom
Page 84 and 85: 5. In general, reflex effects produ
Page 87 and 88: INTRODUCTION When is an upgoing toe
Page 89 and 90: stimulated side diminishes extensor
Page 91 and 92: 30 patients with equivocal plantar
Page 93 and 94: A FHB EHL E TA EHL c FHB TA _j1mV 5
Page 95: Inexperienced observer An additiona
Page 99 and 100: Practical use of the flexion reflex
Page 101 and 102: 1. Contraction of the tibialis ante
Page 103 and 104: FHB I ! ¥ _j 02 FHB ...,. r~~a..,.
Page 105 and 106: Finally the method of stimulation.
Page 107: CHAPTER V THE BABINSKI SIGN AND THE
Page 110 and 111: TABLE XIV THEORIES INVOKING A SUPRA
Page 112 and 113: change of the plantar reflex was of
Page 114 and 115: An upgoing toe response in lower pr
Page 116 and 117: noticed no special features, and of
Page 118 and 119: 'pyramidal syndrome' were not. Thei
Page 120 and 121: movements, but also the capacity to
Page 122 and 123: - rapid foot tapping on the couch,
Page 124 and 125: TABLE XVI FREQUENCY OF V ARlO US SI
Page 126 and 127: ~ N 0\ TABLE XVIII PATIENTS WITH A
Page 128 and 129: ~ N 00 TABLE XIX LACK OF CORRELATIO
Page 130 and 131: ~ '->' 0 TABLE XX PATIENTS SHOWING
Page 132 and 133: 3. BABINSKI SIGNS APPEARING IN OR D
Page 134 and 135: --------------~~- ~ '-" TARLE XXI "
Page 136 and 137: DISCUSSION Two principal features e
Page 138 and 139: patients in the first group in whom
Page 140 and 141: The most striking examples of Babin
Page 142 and 143: eflex arc must have its impact at o
Page 144 and 145: hallucis longus motoneurones to seg
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9. The paradoxical downward toe res
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showed very little agreement with t
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A second condition to be fulfilled
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eide met dubieuze voetzoolreflexen,
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waarin de Babinski-reflex verdween,
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BABINSKI,]. (1885). Recherches sur
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approche d'une interpretation du si
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BUCK, D. de, and MOOR, L. de (1900)
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DEJERINE, ]., and LEVY V j\LENSI, J
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FRIEDMAN, E. D. (1920). On a possib
Page 166 and 167:
GROSS, F. (1971). The Emperor"s clo
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IIDA, M., and BASMAJIAN,]. V. (1974
Page 170 and 171:
LANDAU, W. M., and CLARE, M. H. (19
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MANFREDI, M., SACCO, G., and SIDER!
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NYBERG-HANSEN, R., and RINVIK, E. (
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lombo-sacrCe avec amyotrophie globa
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STRDMPELL, A. VON (1887). Ueber ein
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WALSHE, F. M. R. (1956). The Babins
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ACKNOWLEDGEMENTS I am grateful for
Page 185:
CURRICULUM VITAE De schrijver van d
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